Birnbeck House - Care Home Learning Disabilities

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed 1 quality statement within the Effective key question. We found 1 breach of the legal regulations in relation to safe care and treatment. People told us they were encouraged to be independent with undertaking daily tasks such as personal care and to make choices. However, relatives we spoke with said their loved ones independence and choice was not always promoted. Individual care plans provided staff with the information they required to meet people’s need and preferences. However, we found conflicting information in some care plans that meant we could not be assured that people’s needs were always being assessed effectively.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We were not assured people’s experience of living at the service was in line with right support right care right culture. While people told us they had choice and control in their lives relatives we spoke to said people were not being supported to be as independent as they could. One person we spoke with said the service was comfortable and they were happy. They told us they shower independently, which is their preference and staff are there in case needed. They shared how they made choices and received support in areas they need, such as reading. However, relatives told us their loved one’s independence was not always promoted, they said staff “don’t inspire or encourage [person’s] independence” and “the carers aren’t experienced (in promoting independence) or motivating (person), so (they) are watching TV all day”. In some cases, people were being supported to access meaningful activities by extra support from external services. A representative for a person told us people were prompted to complete daily tasks independently and were encouraged to socialise with their peers and be part of their local community. They told us the interim manager is approachable and information relating to the person is shared effectively.

Staff we spoke with knew people well, including their routines and what was important to them. Staff told us how they supported people with their individual needs in a person-centred way which promoted their independence. They confirmed how they supported people to make choices in areas such as personal care and activities in their preferred way. Staff were able to give examples of how people communicated such as, through pictures or visual prompts. We heard how environmental changes to a person’s flat meant they could be more involved in daily meal preparation and domestic tasks. The interim manager confirmed people were being supported with reviews of their care plans and advocates were involved where needed. The interim manager also told us care plans confirmed where people were having social work reviews undertaken and contained information about what had been reviewed and when. Senior managers told us they monitored compliance using a mixture of meetings, audits, and a service improvement plan. The service improvement plan had identified areas of development required around care plans and activity planners not always being followed.

A professional involved with the service told us there had been several different managers. The lack of a consistent manager had impacted on the quality of the service and a focus on people supported and development of staff skills was needed. They had made an external referral for a specific assessment for a person themselves, rather than this being identified as needed by the service. The interim manager was working to improve the service.

We found conflicting information in one care plan around the use of a lap belt and harness. The persons’ care plan also stated in a risk assessment the person can have difficulties swallowing certain foods although there had been no incidents where they had choked or had a coughing incident. No referral had been made for the person to seek support from speech and language therapists. Combined with a lack of staff training and awareness around choking this presented an unacceptable risk to people using the service. Following our inspection we shared this with the interim manager for them to review and take any action needed. People had not always signed their care plans where they had capacity to do so. However, people had personalised care plans and hospital passports which contained important information about them. Such as, their daily routines, preferred activities, medical history, and information about any health conditions and religious needs. Individual goals and aspirations were explored with people. People were observed to be supported with these, such as attending a college course. Care plans contained referrals made to occupational therapists, GP and the dentist. Advocates were involved with people’s care and support where needed. There were detailed positive support plans in place that covered people’s preferences. One person had their independence promoted using assistive technology. Care plans were being regularly reviewed. We identified a breach of the regulation, safe care and treatment.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.